1. WHAT MUST BE A WELL-CEMENTED PROSTHESIS?
Graham Gie FRCSEd(Orth)
PEOC
Exeter

2. WHAT MUST BE A WELL- CEMENTED PROSTHESIS?
Surgical Technique
Type of Implant

4. A good cemented THA:

5. Conducted by a skilled surgeon
A good cemented THA:
Conducted by a skilled surgeon

6. Conducted by a skilled surgeon
A good cemented THA:
Conducted by a skilled surgeon
Through an adequate exposure with consideration for bony & soft tissue structures

7. Conducted by a skilled surgeon Minimising complications
A good cemented THA:
Conducted by a skilled surgeon
Through an adequate exposure with consideration for bony & soft tissue structures
Minimising complications

8. A good cemented THA: Conducted by a skilled surgeon
Through an adequate exposure with consideration for bony & soft tissue structures
Minimising complications
Using modern cementing techniques & instrumentation

9. A good cemented THA: Conducted by a skilled surgeon
Through an adequate exposure with consideration for bony & soft tissue structures
Minimising complications
Using modern cementing techniques & instrumentation
And a tried and tested prosthesis

10. Conducted by a skilled surgeon Who performs the procedure frequently
A good cemented THA:
Conducted by a skilled surgeon
Who performs the procedure frequently

11. Performs the procedure frequently PRACTICE MAKES PERFECT
Skilled Surgeon?
Gifted?
Performs the procedure frequently
PRACTICE MAKES PERFECT

12. Exposure considering bony & soft tissues
Reduce soft tissue dissection
Post approach preserving piriformis
Don’t take trochanter off
Repair soft tissues

13. Avoid trochanteric problems
Minimising Complications
Avoid trochanteric problems
Reduce dislocations
Avoid sepsis

14. Using modern techniques & instrumentation
Acetabulum
Femur

15. ACETABULUM
Circumferential view

16. Circumferential view Exposure of cancellous bone
ACETABULUM
Circumferential view
Exposure of cancellous bone

17. Circumferential view Exposure of cancellous bone Rim cutter
ACETABULUM
Circumferential view
Exposure of cancellous bone
Rim cutter

18. RIM CUTTER

22. Exposure of cancellous bone High pressure lavage & dry
ACETABULUM
Circumferential view
Exposure of cancellous bone
Rim Cutter
High pressure lavage & dry

23. Primary Exeter Cemented Prosthesis : Socket Lavage

24. Exposure of cancellous bone High pressure lavage & dry
ACETABULUM
Circumferential view
Exposure of cancellous bone
Rim Cutter
High pressure lavage & dry
Iliac suction

25. Iliac Sucker

27. ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter
High pressure lavage & dry
Ilial suction
Cement pressurisation

28. Primary Exeter Cemented Prosthesis : Pressurizing Cement

29. Primary Exeter Cemented Prosthesis : New Cup Insertion

30. ACETABULUM Circumferential view Exposure of cancellous bone Rim Cutter
High pressure lavage & dry
Ilial suction
Cement pressurisation
Flanged socket, highly crosslinked poly

31. The Socket
Contemporary technique
Primitive technique

32. FEMUR
Good exposure

33. FEMUR
Good exposure
Clean & Dry Canal

34. Gun insertion of cement
FEMUR
Good exposure
Clean & Dry Canal
Gun insertion of cement

35. Gun insertion of cement
FEMUR
Good exposure
Clean & Dry Canal
Gun insertion of cement
Pressurisation

36. FEMUR Good exposure Clean & Dry Canal Gun insertion of cement
Pressurisation
Delayed insertion of a polished stem, collarless & double-tapered

37. FEMUR

38. Primary Exeter Cemented Prosthesis : Femoral Cementing

39. Post-op
11yrs

40. 12yrs
Post-op

41. Cemented THA with a polished stem
– up to 33 years follow-up

42. Survivorship curve of the original polished Exeter stems -
: end point revision for aseptic stem loosening S u r v I o s h p %
Survivorship 93.14%: 95% C.L %
Survivorship 93.14%: 95% C.L %
Years since operation

43. Survivorship curve of the original polished Exeter stems 1970-
75: patients under age 60 at operation. End point revision for
aseptic stem loosening S u r v I o s h p %
Survivorship 87.22%: 95%CL – 100% (68 cases)
Survivorship 87.22%: 95%CL – 100% (68 cases)
Years since operation

44. Original cups 1970-75; survivorship with end-point revision
for aseptic cup loosening S u r v I o s h p %
Survivorship 72.45%: 95%CL %
Survivorship 72.45%: 95%CL %
Years since operation

45. A 12-17 YEAR SURVIVORSHIP STUDY OF THE EXETER UNIVERSAL CEMENTED STEM
This paper describes the 12 year results using the Exeter Universal stem.

46. 100% stem survival at 10 – 17 yrs

47. CEMENTED EXETER THA IN PATIENTS AGED 50 OR LESS
10 to 17 year follow-up O

48. DETAILS OF YOUNG HIP REVIEW
Patients
Bilateral arthroplasties 23
TOTAL No. HIPS:
Follow-up: Range: – 17 years
Average: years
No case lost to follow-up
Died of unrelated causes: 7 hips

49. DETAILS OF YOUNG HIP REVIEW
Mean age at Sx 42yrs

50. 12 REVISIONS LOOSE STEMS 0 LOOSE CUPS 9 (6.8%) CUP FOR LYSIS 1
RECURRENT DISL 1
INFECTION
LOOSE STEMS 0

51. Here is the survivorship line for the stem with an end-point of re-operation for aseptic stem loosening.

52. WHAT MAKES A WELL-CEMENTED THA?
Excellent technique
with a tried & tested prosthesis

53. Thank you for your attention